Provider Demographics
NPI:1073796991
Name:BRIAN J LANKFORD OD PA
Entity Type:Organization
Organization Name:BRIAN J LANKFORD OD PA
Other - Org Name:TARBORO VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:LANKFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-823-3202
Mailing Address - Street 1:807 WESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-4014
Mailing Address - Country:US
Mailing Address - Phone:252-823-3202
Mailing Address - Fax:252-641-5087
Practice Address - Street 1:807 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-4014
Practice Address - Country:US
Practice Address - Phone:252-823-3202
Practice Address - Fax:252-641-5087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1305152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC410030251OtherMEDICARE RAILROAD
NC09278OtherBLUE CROSS/BLUE SHIELD
NC8909278Medicaid
NC1005560001Medicare NSC
NC2466604CMedicare PIN
NC410030251OtherMEDICARE RAILROAD